In this insightful episode, we explore the transformative role of play and playfulness in paediatric occupational therapy from multiple perspectives. From real-life case studies to theoretical discussions on the STEPPSI model and polyvagal theory, we uncover how play enhances child development and therapy. Learn about the challenges and triumphs therapists face in incorporating fun into clinical practice, and discover strategies for balancing playful engagement with therapeutic goals. Through stories, research, and practical tips, we highlight the profound impact of playful interactions and social dynamics in fostering growth and emotional regulation in children.
00:00 Exploring Play in Child Development
01:16 The Origins and Evolution of STEP SI
05:24 Personal Journeys into Pediatric Occupational Therapy
08:05 The Vulnerability and Joy of Play
10:03 Balancing Playfulness and Professionalism
20:55 Clinical Reasoning in Play-Based Therapy
25:18 Playfulness vs. Play: Definitions and Applications
28:45 Case Study: Attuned Play in Therapy
33:19 Struggles with Play and Skill Development
34:28 Letting Go of the Agenda
35:30 A Breakthrough in Play
38:22 The Importance of Play in Therapy
39:28 Navigating Play and Regulation
41:31 Personal Reflections on Play
45:20 Autonomic Nervous System in Play
47:15 Grandchildren and Play Dynamics
53:06 Therapeutic Strategies in Play
59:14 Concluding Thoughts on Play
REFERENCES:
From Ayres to SI Theory: Anita Bundy Play: From Ayres SI Theory to Therapy - Dr. Anita Bundy - YouTube
Dan Siegel River of integration: https://www.facebook.com/drdansiegel/posts/think-of-chaos-and-rigidity-as-banks-along-a-river-harmony-emerges-from-integrat/10153524102792208/?_rdr
Dr Diane Parham (PLAY) https://vivo.health.unm.edu/display/n4031
Richter, E., Oetter, P. (1990). Environmental Matrices for Sensory Integrative Treatment. Environment: Implications for OT Practice. American Occupational Therapy Association, Maryland.
TRANSCRIPT:
[00:00:00] Cory: we kind of wanted to explore play because we were just talking about following a child's
[00:00:05] lead and evincing an
[00:00:07] adaptive response and So much of that, because we work with children and their primary childhood occupation is play
[00:00:18] Yeah.
[00:00:19] We, like, want to be across that and figure that out in a very, I don't know, precise therapeutic sense.
[00:00:26] So we're trying to disentangle that, Michelle, like you said, but just a thing that we are, we're just a playful person versus the elements of this that, I don't know, we can work on in our therapeutic, toolkit and our being, I guess, we're all about fleshing out lately. Anyway, um, these terms, these terms that we all just use very frequently and really coming at precision around these terms, and Tracy has playfulness specifically set out in the STEP SI as a particular element that we can think about when we're clinically reasoning and planning. So maybe, do you think Tracy, it would be useful just to sort of voice why that landed on its own shelf and how that came about, maybe?
[00:01:16] Tracy: sure yeah, so, you know when we first did this step Si Sharon Trinnell, Julie Wilbarger, and I put this together back in the 1990s in 1997- 98 we were really teaching it a lot. We went to the AOTA. We presented it. We formulated it Um, and then it's been used for all these years, the STEPPSI, and it used to have one P, steppesi, um, because play and playfulness were sort of inferred in it.
[00:01:46] It was kind of held in, um, a couple of places in the steppesi, intentionally. We thought that it was held because it was a sensory integrative
[00:01:58] approach and so Dr. Ayers always talked about play was part of the essential ingredient of doing the work of sensory integration. So in that way, it was kind of almost like inferred in the background beat of course, this is a play based approach, but then also in the S T E P S I, play could have been coded in a couple of places.
[00:02:24] It could have been coded as the interactional element, what's happening in the relationship, and because it's a play based experience overall, maybe it, resonated in the I of interaction, or it could have resonated in the T of task. But then after we develop this STEPSI and you kind of go forward, there's been such a beautiful emphasis on studying play and playfulness. in a lot of different disciplines, but in occupational therapy, it is looked at in such a rich, beautiful way. And you know, a number of people, I think Anita Bundy and Diane Parham are the people who really come to my mind when I think about this work, but there are many others who have been looking at play and playfulness. Um, Anita developed this test of playfulness so there's a focus on it, but it's a really rich idea. And then, of course, the intersection that I'm always interested in is that how does a brain science kind of view of, of play and playfulness inform us? And I've been really deeply, um, you know, reading for many, many, many decades now.
[00:03:46] The work of, like, Jaak Pinksepp, who, in his social affective neuroscience work, talks a lot about play, um, and that is a really important intersection. And then, of course, the theory approaches that we thread together around play and floor time and relationship integration and interpersonal neurobiology and attachment and just the enriched experiences that it really takes to foster development. All of those have connections to play and playfulness. So it made sense as that literature has unfolded to just pull it out and add it as an element in the step SI so that it wasn't so much in the background beat, but that was more foreground. Yeah, and I think it's been a really important thing to pull it out and add it back in a focal element itself. So it brings up the question though around the differences between play and playfulness, which I
[00:04:58] think is an important thing for us to probably, uh, think about, but for both of you, I wonder about how having the notion of play or playfulness, both and, in your minds as you're treating, you know, kind of becoming a pediatric OT, is play natural or was it something you had to reinvigorate in yourselves?
[00:05:24] Kind of, yeah, just talk about your journey of becoming a player.
[00:05:29] Michelle: I, have had a really varied career before, uh, coming to paediatrics. So I used to work in Sydney in Sussex street in a head office. Um, so I wore heels in a suit and I, Convoyed over the ferry through the center of CBD, Sydney. And I got my piccolo and, you know, my briefcase and I didn't have airpods at the time, but I really would have liked to, cause, so I came from that.
[00:05:56] I moved to Orange and was part of a project team, um, looking at clinical governance. So I got rid of the heels, but I was still in my suit. So I think the first time I met with Sarah, we sat on the ground and, uh, she took her shoes off. I was like, what the Like, what are you doing? You're undressing in front of me.
[00:06:19] Like, is okay? So I felt very, um, exposed and like, what is going on here? And then I was like, it's kind of cool, but this is a little like, I don't know. So I'd gone from Board room to, um, on the ground with my shoes off and wearing tops that didn't show my breasts and you know low rise clothing was in at the time so I had to modify low rise to high high high rise.
[00:06:50] look there was some adaptions I had to make. you know, in my dress and in my head space to be able to squat on mats. Then, um, yeah, I think one of the first things she showed me was, the hammock swing, it's like getting into a hammock swing and, you know, doing linear and pulling on the rope and climbing up.
[00:07:10] Some of the first things we do with all of our OTs, which Sarah certainly did to me, was get me on the equipment and learn how to use it. And so I just was like, wow. It was simultaneously a culture shock. And once I got over that, it was like, my body feels good. We laughed, like we just laughed. And I think I felt the joy of that because whilst I had, you know, young kids of my own, um, and I was playing on the ground, I wasn't necessarily doing it publicly or with my professional hat on.
[00:07:44] I was in the parks and sitting on the ground on picnic rags and, crawling with kids. But that was not my profesional persona. So, um, yeah, it, um, felt like a coming home and a real integrating of the different aspects of myself, I guess. So, um, yeah, I've been on quite the ride, but I super love it now. And you kind of have to, and the first few times I was very conscious in front of people, you know, and adults are watching and you're like, rawr, you know, you're roaring and you're on the ground and you're ball wrestling, or like you really in amongst it, I have no filter now as.
[00:08:23] Um, you would not either, um, because you can't be present with the child truly and be worried about whether you got your roar loud enough or too soft or, you know, how are you positioning? Do I look like a bear for real or not? You know, all that stuff you just can't worry about. So that was a bit of a journey too, cause I felt very, just aware of being an adult on the ground, playing in front of adults. Um, yeah, anyway, I love it and it's the greatest joy and that's why I would never leave the pediatric OT because it will keep me young, really.
[00:09:00] Cory: percent. I, I'm very, different in my way of coming to this process. So I love hearing how you landed it Michelle. Cause it's so, cause obviously I went straight into pediatrics and so, um, and not even intentionally, I was just like, just get me a job.
[00:09:17] I just need
[00:09:18] to get in and get some jobs somewhere. And I landed in pediatrics cause that's the job I had. And because I was kind of, um, very untethered in that first job that I had, I had. actually nothing, to my knowledge set other than, my playfulness. As in, I was still learning, I was fresh, and I didn't have much mentoring, and I wasn't watching other clinicians.
[00:09:39] I just was, like, lucky that I, Uh, could relate to kids like instantly. Um, I think in my upbringing, I guess I'm very, very lucky that, I have a very playful family. So, and my dad is so very playful. So is my mom. Um, but I guess that. I got that experience, so it didn't feel like a stretch to be play, or it doesn't feel like a stretch to be playful, so I'm very, I know that's not the case for many people, um, so I think the thing that I did struggle with though, in the same way that you did, Michelle, was having people watch you, because play very vulnerable, like you said,
[00:10:28] can't um, like you can't, not, you can't like hide yourself somehow, like you
[00:10:33] kind of really be authentic to be playful.
[00:10:36] And so, initially I had that same kind of like, well, this is really embarrassing, like someone is like fully watching me, like I have these dolls and this child wants the dolls to cry and like, oh, you know, not even just dolls, like any sort of play, like you have to embody it.
[00:10:51] And so to embody it, you kind of have to feel really, um, I guess I want to say confident, but it's not confidence, just, sure in the way that you're coming to the interaction so that you don't, second guess what you're doing because then you can't really connect to the child in the moment. Um, and now I just have no, I actually, I think it's just a getting used to that discomfort,
[00:11:13] that maybe. And maybe it's a, um, seeing, seeing the benefit of doing that therapeutically that kind of reassures you to keep going at that maybe. But I just, I think now it's like parents, I think they just love watching that.
[00:11:32] It's like they get some level of joy and release from seeing that happen and you feeling so comfortable in doing that kind of permission to let go a little bit.
[00:11:46] Michelle: yeah. Tracy, what's your experience? Because I know you've had a really academic, you've got two things happening as well. You've had a academic research, you know, your director, mentor for, you know, and a leader profession. yeah. How did, how's play feel for you
[00:12:05] Tracy: Yeah, so, you know, I didn't, uh, know exactly, like, where our conversation would go today and honestly, this is like a memory that just came to me from listening to both of you just now. So this is, so let me kind of, where do I want to go with this? So, um, When I was first becoming an OT, okay, we, I don't even know if, uh, you know, globally it's always the same kind of process, but for our uni, approach to it was that we did this thing called a level one field work and then a level two field work, that were a part of our training.
[00:12:43] And so the level one field work was a little bit more of this short term, one week, placement, and you went into a setting. And so my first level one field work was like an adult rehabilitation, and it was quite a serious sort of more medically oriented environment. And people were struggling with really significant injuries and, there was such a steep learning curve in that first one, but it felt kind of like a serious environment, if you will. And it felt like such a cool thing we actually had to wear white coats back in the day. So that was like even more serious, you know, and, we're like medical professionals. And so then my next one, was in a regional center for, and these hardly exist anymore. So it's odd for me to think back on this, but it was a regional center and it was kind of a place where kids who had a lot of layers of difficulty and maybe their family or their school district had elected for some reason to have this, these kids go live basically.
[00:14:01] So it was sort of like a residential setting, but it was a state placement. It was pretty serious in that way. And a lot of these individual kids had all different kinds of layers of things going on. And, um, even though in my life, I had been exposed to kids with different kinds of needs. I had never been around, 80 kids who were all like really, really, really struggling with, ambulation and eating and all of those things, right? So it was a big experience, honestly. And I was certain I wanted to be a pediatric OT, but you show up and then you're trying to be the professional student that you are. And I remember being in this session and this OT, who I still know, um, all these years later, but she, she was so gentle and loving. But a little bit procedural, I would say now, in knowing all the things that I know now, at the time I just was observing and absorbing and taking in, and then in the next day or two, it was sort of my turn to take a crack at what was happening, right?
[00:15:15] And I felt in my, inner self, uh, kind of a need to connect with this little girl in more of a playful way. And so I, it was really kind of almost like range of motion is what we were but I felt like when I added some rhythm and some sound that she connected differently and allowed me in and the therapist kind of looked at me like, what are you doing?
[00:15:46] You know, and It was so funny. And I remember feeling so vulnerable.
[00:15:53] Um, but also like, I really remember hearing Ellie Guilfoyle in my head saying, you know, what does it mean to have purposeful activity? Really? What does that mean? And to me in that moment, play was a solution to having that thing that had to happen to this young child, uh, in order for their kind of physical wellness.
[00:16:17] To be supported and taken care of, but it didn't have to happen to her. It could with her. And I remember feeling afterwards, really vulnerable and having a lot of questions about the approach. And when I went back to the uni after the experience and talked with my. mentor, professor, and just explain, she was so like, yes, you're doing the right thing.
[00:16:44] And it was really affirming. But I remember, just feeling like, you know, and so many times since then in our profession, I have encountered moments and I think we all have where this space
[00:16:59] of doing too versus being
[00:17:01] with, happens. And I think play and playfulness. Are a space of kind of authentic connection and it can create meaning even in the most perfunctory thing like range of motion, you know what I mean?
[00:17:19] So anyway, I just remember the vulnerability of those moments and just the questions in my mind about what is this work and what are we doing and,
[00:17:31] and what is the thing, you know?
[00:17:33] Cory: yeah. Now my questions are like, I know the parents' like, okay, you're clearly. Um, connecting with my child and engaging with them and they're doing all these things. But the parent probably is wondering what the heck am I doing? So now I'm like, yeah, okay.
[00:17:51] The questions are different, but I have I guess because my clinical reasoning is so much more robust, I feel so comfortable in what I'm doing that I have no worry about it in terms of even if I don't know exactly what's happening. I feel like I can help the parent understand the value in what's going on to be able to explain to the parent what actually is happening in this moment that's useful and really important. Um, and so that has, I think, relieved my, uh, self consciousness maybe around like what, being playful and just, I guess, being able to explain that thing that I'm addressing in the play and why the play is really important, um, has been useful too.
[00:18:34] Michelle: And I think that some of that comes about with the, um, parents perception of what the value of play and the value of those gentle, attuned interactions. You just described then, Tracy, versus when are you going to do the procedure? When are you doing the thing, Michelle? Like, when are you going to start working?
[00:18:56] Um, I'm just started working with a new family and they said to me yesterday, like we had missed having the intro conversation. So we went straight from assessment to an intervention session and I caught up with them that afternoon. And, um, I said something, you know, do you have questions? I'm sorry that we've, you know, wasn't able to explain what was coming up, um, before you actually saw it in action.
[00:19:21] And they just said, we trust you, Michelle. You, um, we see that we know what you're doing. He's doing things with you that we cannot get him to do. Um, We trust you. Like it was just so lovely. It was really in tuned. It was a bit gritty for sure. He has vestibular and, um, somatosensory, discrim issues. It's bumping into modulation.
[00:19:47] There you go. If you listened to our last two podcasts, you'll know what I'm talking about. So, you know, I was bumping the edges and he, um, anyway, the family. Uh, um, are intuitive type people who value play and value, um, that gentle attuned approach. And so they were like, Oh wow, you, you do that thing that you're doing there.
[00:20:07] And I don't really need you to go into the merits of playing. play and the merits of we space where other people who really value the procedures and the doing of and let's educate our child here and you know they want a more dare I say behavioral approach or a top down teaching approach. Um, I think play may not, the value of play isn't as obvious for them and um, um, they might have a harder time seeing.
[00:20:39] what we're doing and valuing the use of play in, in sessions. Um, that's my experience, I guess, about how different families and beliefs and values around play present.
[00:20:54] Tracy: Yeah. I, well, it, it brings up for me a couple of things and that is that, you know, the research literature tells us a lot about play and playfulness and what they are, but here's the thing that I think we do in the STEP SI, and I don't know that I've read this anywhere else, I could be wrong and I'd be love to hear if, if I'm missing something here, but here, here's what it is, is that, um, play this is not a novel concept.
[00:21:23] Play is both a means and an ends, right? So it's the methodology. But the thing that's interesting in clinical reasoning is that you have the opportunity as the clinician to be fully in the present moment with the child, but your brain and your kind of ideas about what's happening are also constantly While constantly present, you're toggling between
[00:21:57] thinking about the goal or the not goal.
[00:22:02] And what I mean by that is that, In the research literature, we know from about play that in some ways, the skillfulness and this is the secondary outcome of play
[00:22:16] and that, uh, the primary play is really just about the whole of the child, the enrichment and the actual... Almost the intangible benefits of what to be a player is what it means to be a human.
[00:22:31] It's so entwined with our essence of being a person, especially in developing children. So, so the thing that I think the STEP SI helps you with is, is that in those moments of uncertainty is to pause and to allow yourself to say, am I working more on the means or the ends of play? And how can I deepen my understanding of that work? So when I'm in the moment with the child, I might intentionally allow that deepening to happen. So it's, you know, frequently in our podcasts, we use this idea of zooming in and zooming
[00:23:14] out. Um, because I think that that's like shorthand for all of what we do in clinical reasoning, but play and playfulness require this constant zooming in and zooming out.
[00:23:28] And all at the same time, you're releasing your attachment to what it is,
[00:23:35] and that's a tricky space to work in. Does that make sense?
[00:23:40] Michelle: Totally does. And for me personally, who, my, one of my key learnings from when I was studying, um, one of the modules in the DIR was around, um, being with and staying, you know, wait, watch and wondering with the child, and I could do that for a period. But my own, um, individual differences had me going, I'm bored now.
[00:24:04] I've had enough of this. And, and how can I get you to move on? Um, so I found myself, you know, trying to stop, I videoed myself as you have to do. And I was saying, it was like, right, don't move the game on Michelle. Don't move the game, you know, let this happen and, but keep playful. And for me, to try to maintain being present I started teaching. So I was like, oh yeah, the green car's going up the ramp. Vroom, vroom, vroom, vroom, green, green, down, down, down, down, down. And that was my own, like you can still do that, but I was just like, okay, this play's getting, you know, not meeting my true needs at the moment. So. I'm going to be a teacher to fill my need up for doing something for the end, for getting some skills in there while we play.
[00:24:57] Anyway, it's so
[00:24:59] Interesting because, um, if it's a little slower than my personal preference, then I get worried about the end. What are we doing here? Okay, let's do colors. Let's do concepts up, down, below, you know, I, I get teachery and that's, um, my own impatience
[00:25:17] Tracy: yeah. But it's also, I think, a really natural thing that happens to everyone, especially adults. is that we shift from playfulness into play. So maybe we should talk about like definitions of that a little bit, right? Because, um, in some ways playfulness is more of an attitude versus play is more of a verb.
[00:25:41] It's like an action and it is a task and it is a doing, right? Versus the being part, which is the playfulness. And so In the playfulness space, that is an attitude. There, you know, there are different ways that people describe this and I think Anita Bundy has these, you know, elements that, that are defining playfulness, we'll post that probably in the show notes so people can look at her, her definitions, but what I think is interesting to notice in your own work is when you toggle between playfulness and play. Playfulness And play. And it's also really instructive to hang in that space of toggling between them a little bit with an individual child to help you learn the differences between them because often when we turn it into play and we take the agenda to turn it into play. That turns into that teachery space that kind of, and not teachery in a pejorative way, but it just is an option in our interactional style to shift into, more task structuring of the play. But as soon as we do that, we take away the freedom from child's exploration. And for some of our kids, that promotes play in other kids, it reduces their play. And that's really based on the individual differences of the child. And it shifts you from working more on you know, the outcomes related to regulatory capacity or the outcomes related to higher level skillfulness and praxis and skill acquisition versus the outcomes that are related to our social interaction.
[00:27:36] And, but then there's this higher level, just being as a whole person that develops in the context of play. So we would have this map of all the applications of play. And obviously I'm not listing them all because language and, you know, thinking skills and problem solving and expansion of, um, our sense of self, all of these different things, are related to play, but you want to notice that when you shift between the attitude of playfulness and really being more child led versus your desire to toggle to the skillfulness that might available if we focus the play a little bit. And there's an artfulness between
[00:28:26] shifting between those places. There's not like a one is better than the other in a moment there's a decision to be made. Um, yeah, so those definitions are kind of broad I, I don't know if those land or if you want to, you know, deepen those definitions or, or
[00:28:45] Cory: I was just thinking I could maybe demonstrate this from an experience I had like just last week. With a kiddo, um, at daycare, that might I guess reflect what exactly what you're saying, Tracy, which is like, am I going to show up and embody, um, playfulness with this child and, and use that throughout, um, any of the particular things that we're doing to facilitate his sustained engagement, to facilitate his language, working memory around staying with a particular idea am I going to do that or am I going to, um, kind of, Try to address really the clear, clear, clear, clear vestibular discrimination issues that I am like, Oh my gosh, they're humongous.
[00:29:31] And I really feel like I need to get some precision into that system. And so I guess to give context, I, was playing with this little boy in the sandpit and, just observing him in his general environment, he's, overwhelmed by the, any sort of social, uh, I want to say assertiveness from his peers.
[00:29:55] So a peer sets an idea and I can, from my gut sense is that he doesn't really want to do that idea from his body language and the way that he's kind of pulls into himself. Um, but he has no capacity to sort of, um, Problem solver has set himself back. So he just kind of gently moves on to something else. But you know, daycares that to a very busy dynamic environments and you're never that far from another kid coming in, join you on something. Um, especially when you have the OT there, they, those darn OTs, they're just so enticing to everybody. Um, anyway, so , the reason I give you that picture is because I don't suspect he gets a really nice, attuned, enjoyable, social play experience.
[00:30:46] And so a lot of his play looks very, repetitive, kind of structured, building activities solo. But he's just such a, caring, connected beautiful kid when the, um, situation allows for it, if that makes sense. So every time I show up and he looks at me and he processes me and we're like, they're playing a little basketball game and he goes. I'll make some space for you. And so he moves over and then I sit beside him, you know, so he is able, very, very able and wants to connect and is very sweet. But I don't know if he gets many attuned interactions that build his, capacities that are tricky for him around like language and processing speed and body awareness and staying with one idea.
[00:31:31] So anyway, that's some context for him. We're playing in the sandpit and in front of my eyes. I'm watching this right eye of his wander in and out of alignment. And I'm like, I know that this is, needs to be addressed. Like, I need to get you to, um, get some input that might. Maybe pull that I back in a little more readily so you can really perceive your world well visually, um, and find the stop in your own body, like in from a vestibular standpoint, really find yourself in time and space, because that's really hard for him if I move out of his close, I would say, um, in the Patti Otter womb mother play kid power space, you know, the progression of space.
[00:32:20] Um, is it Patti Otter? Did I get that right? Who,
[00:32:24] Tracy: Yeah. Yeah. Patty Otter and Eileen Richter.
[00:32:27] cory_1_03-22-2024_091607: Yes. Yeah. So if you're thinking about that theory, I'm sort of in mother space to get him to really, um, maybe mother and maybe like two to three meter away from him to really get him to place me in space with him. Um, And all of this I know is related to his vestibular discrimination, somatosensory issues that he has. And so we're playing a game that I've really, like, playfully followed his lead around in the sandpit with some dinosaurs. And he wants to have the dinosaur. Shoot a fireball. And so I'm with him in this and we're, I'm really attuned to this point.
[00:33:05] And then I'm like, I need to get you to move in this. I need to get you to do some head rotation. We need to do some something here around this vestibular piece. And I'm like, okay, but the fire, the dinosaur won't fire up the fireball unless we power him up. Um, way too complicated for him, he had no idea what I was talking about and, um, way too abstract and I'm like trying to get him to do just the basic like robot zaps from astronaut pre training protocol kind of thing where you stand back to back, your feet stay planted and you rotate to tap each other's fingers or we were just trying to pass the dinosaur around, that's what I was trying to do. he had, he, that was never gonna fly. He had no midline orientation. Every time we tried to stand back to back, I had no other kid to demonstrate. There was no, I was, I was just in a world of struggle. And now, cause I was trying to get to the skill. I was trying to be play, play, but I was trying to get to the skill and I, and he kept turning his whole, like he would try and pass me the dinosaur.
[00:34:04] He just turned fully around to face me and to face my back. And I'm like, no, no, no, your feet have to glue to the ground. And then I'm like, what are
[00:34:11] doing, Cory?
[00:34:12] Michelle: Here, let me stuff, stuff up this play just a little bit more for you, honey.
[00:34:17] cory_1_03-22-2024_091607: yep. I was
[00:34:18] Michelle: me get in the road.
[00:34:19] Cory: I was like, literally, this is not in any way useful right now. And stop, just stop. Like, just let it go.
[00:34:28] Let go of the agenda to address this, you know, somatosensory discrimination, vestibular stuff. There'll be other opportunities for you to figure this out with him. That's too complicated. Like, you know, just go. Get him to, shift his focus from visually from you to the, to the dinosaur, you to the dinosaur. That actually is building some of the discrimination skills that you're trying to address. Lack of the silly thing that you're trying to do with this child that is not useful. So I did. Let go of it, and we kept playing, I think I said, oh man, this is just not the way to power up the dinosaur, is it? How we get, what do you think we should do? Like, how should he get the power ball? He's like, let's just do this. I said, that sounds great, let's do that. Um, But like that urge for me to really kind of hit that system that is just so tricky for him Was so strong like I know that can be really hard to dance that dance anyway, so He this week just recently gone.
[00:35:30] He was playing the dinosaur game again. And, um, he decided they needed ramp and that the car was out of battery, and that he was going to go and call battery world, which is really complicated for like his language and stuff at this point. And I said, oh, okay. Um, like that sounds really good. Like that's a good idea.
[00:35:48] We need a battery. Um, and so he went over and call battery world, but I was trying to stay in place because he moved away from me in space, further away from me in space. And I was like, don't follow him. Just see if he can sustain this idea and come back to you. Can he keep hold of that goal that he's doing right now?
[00:36:09] Like, can he stay with that? And he moved around the corner, out fully, out of sight. And it was taking a little while and I was going, is he inhibiting all the other toys that he can see? Or is he just picking up all the toys and not staying with the idea? I was like, just wait, just wait, like to see, cause that's exactly what he would do normally is he would move through into a different space and then completely lose concept of anything that had happened and he'd move.
[00:36:37] And two meters in space and that idea is gone and it's become the whatever thing he sees in the moment. So,
[00:36:42] Michelle: Cory, but he's probably thinking that about you. We were just doing fireballs and she just went and wrecked it on me. Like, she just took me over here and she was trying to do this
[00:36:53] he's Cory really needs to
[00:36:55] improve her play skills.
[00:36:57] Cory: He was sweet. He was just like trying to like, he was like following along. He's okay, do what this, I guess. Like, but it was no, not conducted for him in any way. So I just let go of that. But anyway, so he moved away, did this battery thing and it was taking him a while, so I was trying and I couldn't see him and I was trying so hard not to follow him to see if he could do this. And so I called out, Oh man. I really hope they have a battery because we really need a battery over here. And he goes, I'm hurrying, I'm hurrying. And then from a, from a distance, and then he comes back and he comes back with sea creatures and a battery. Cause I saw the sea creatures being like, Oh no, it's just a new idea.
[00:37:41] It's not the battery. He just now wants to play sea creatures, which is what he normally do. But he goes, Oh no, I have some sea creature friends with a dinosaur and the battery. So. That was exciting for me because that's, again, that's a reflection of his improving skill in the exact thing that I was trying to regimentedly address, um, and I was getting it in play, um, rather than, yeah, getting bogged down in the playful but not really, uh, I don't know, attuned activity that I was trying to get him to do.
[00:38:14] Tracy: So good, such such a relatable story, right? I mean, just the whole struggle of it. Um, and I think, you know, so suspending clinical reasoning and allowing play to be the winner all the time is often the very best solution because It, you know, it reveals the wisdom of the child's own system and it's so authentically aligned with all of our theory bases. Um, and sometimes, you know, we get, as you say, greedy, right, Michelle?
[00:38:50] we get like, oh!
[00:38:51] squadcaster-899a_1_03-22-2024_101607: can agree.
[00:38:53] tracy_1_03-21-2024_171608: Yeah, totally. So, so true.
[00:38:57] squadcaster-899a_1_03-22-2024_101607: sometimes, um, play, I guess I can really relate to that. And, you know, a lot of the kids who you can partner, a little bit more readily, they've got some more capacities, I guess, across all the domains. There's certainly some kids that we see with, challenges with regulation that, that play state, um, and a bit being a bit more playful, um, can make it harder for them to stay in that regulated state. So
[00:39:27] Michelle (2): I know Cory, you've
[00:39:28] squadcaster-899a_1_03-22-2024_101607: done some work and Trace, clearly this is your lane, but around that, what happens to the state to move when, when we move into play. So that's, um, being with another where I'll be and being flexible and creative is a big um, ventral state.
[00:39:45] And so sometimes, um, to come up with more
[00:39:48] Michelle (2): ideas, like Cory's like, yeah,
[00:39:50] squadcaster-899a_1_03-22-2024_101607: let's do a fireball. You know, that idea can keep, you know, activate us to sort of be sympathetically, um, in a blended state, ventral sympathetic, blended state. Some kids do struggle with that, that that can have them. Yeah, I'm just going to go and get the battery over here.
[00:40:07] I'm just going to jump off the loft and then I'm going to da, da, da, da, da, da. So, um, the energy of playfulness, um, and the freedom that we allow, I guess, in that state. And if we're, um, you know, embodying or reflecting their joy in, Oh, great idea, get the fireball, you know, that can tip them over and all of a sudden they're, you know, bumped up to their edge of regulation and they're off without us, or they're jumping off the loft or, you know, whatever, they're a bit more energized.
[00:40:38] So sometimes, um, you know, I guess the opposite is that is where we bump into rigidity, where we jump into no, no,
[00:40:45] Michelle (2): no, no, no, Cory, that's not,
[00:40:46] we don't need a battery, we don't need a battery, or we don't a fireball, you know, which is that rigidity, I guess. Um, yeah, so it's interesting, the examples, we've used is where kids have more capacity, but are play, has to be just right in terms of how we're reflecting, um, their non -verbals and their energy, as well as the ideas that might have them doing, um, more on the go kind of let's destroy the jungle, um, or, you know, the fireball example.
[00:41:19] It's like, ah, all of a sudden, you know, we're much more activated that might, um, pull us out of that. combined blended, ventral mo that we talk about.
[00:41:31] cory_1_03-22-2024_091607: That just made me think of and reflect on early experiences in, just my career, I guess, just my individual differences when a kid's playful and really motivated around something, my nervous system will shift very quickly into like, yeah, let's do that. And for me, just in the way that my brains put together, I'd quickly go into a much, much higher level creative thing than the child was ready for. Often, it's like, oh, they have this like very start basic simple idea and I'd be like, yeah, let's do that and this and this and this and this and this, you know, I'd be like trying to lay in top of their idea, but that would be way harder way, this is before my DIR training, you know, just before lots of reflection and really figuring this play thing out. It would just be a mismatch in terms of their current capacity in play. And the intention was to join them in play state and to, make the play more creative or more complex even I guess but just knowing how that plays out in my individual treatment I guess my profile as a therapist of being like, okay let's just stay with where they're at. And I find kids, Michelle, like if I push, if I feel like I'm pushing or going too far, I always hit rigidity in that other profile. but that has taken a long time to come to that process and to figure that out on my own. I guess being of it as a therapist. So interesting.
[00:43:01] Tracy: Yeah. Absolutely and those edges you know Dan segal's flow of the river integration has chaos and rigidity as those banks. And I think in, in the sessions and when you're playing and, you know, with yourself or with the child, you can feel, I think naming it as the chaos or rigidity helps in a way, right? Cause you can really see like, Oh, I went, I went beyond where this kiddo's capacity is to hold the playfulness. And when you learn in the DIR framework and the FEDCs, it's also interesting to me how very often, especially therapists who are newer in their work and they're coming into being a pediatric clinician, they'll often think that play is kind of equated with pretend, right? And it's very symbolic and it has a lot of this kind of, you know, turning the block into a building or the, the, that the animal even has animation to it and is alive. And a lot of our kids don't, aren't at that level. And so their play is. Not there. And I think learning how to play at these in these different ways that you're really, where is the child? Where's their focus? What's it about for them? And is it just about the movement itself? Is it about the object interaction? Is it about the interpersonal interaction? You have so many different layers that are happening there. Uh, and there's a lot to learn and a lot to unpack, but, um, Yeah, I think that those are often things that I'm encouraging therapists, as they're learning, to release your attachment, um, to what does play, what does play have to look like? Because, uh, then it constrains and it gets more rigid, um, and then it can make the therapist feel more chaotic. And so how can you find that kind of ease of just being with, allow the play is always the place to go back to kind of into the flow is what you're striving
[00:45:18] tracy_1_03-21-2024_171608: for. Yeah,
[00:45:20] Cory: just, previous to what you're saying, Trace, Michelle, you touched on the autonomic functions around like how we can, I guess, how we can dance the dance with the autonomic nervous system in play. I know much more recently I've, started to get my head a little more across the blended states around the polyvagal theory. So, having the access to more than one kind of state, which makes total sense to me. It's a, how the nervous system can, move and respond to the environment in the most adaptive way, I guess. So what, what I mean by that is, if I'm playing, I need to have some level of sympathetic, activation so that I can do that mobilization of energy in the play space. But what I was reading when I was kind of looking at play , play and regulation really was what I was kind of. thinking about because we use play in our treatment a lot to work on regulation functions. And so it was like, okay, sympathetic mobilization, but then it's coupled always with the break of the ventral vagal system. So that the sympathetic activation doesn't become too much and then we feel fearful or worried or activated or, and you know, I guess it's like somewhat, yeah, it's like, yeah, too chaotic, I guess, is you know, chaos of rigidity. If Maybe you might be able to explain that better, Tracy, like what's kind of happening in terms of the blended states and how those two, the sympathetic activation and then the ventral vagal break kind of dance?
[00:47:06] Tracy: Yeah, absolutely. I, I mean, I think you, you explained it really well, actually, Cory, but
[00:47:13] here's what it brought up for me. Okay. So recently I'm a grandma now and I was recently, um, spending a weekend with my grandchildren. So they're four and two, the four year old is a boy and the two year old is a little girl and they're really learning how to play together, but they have really different energies.
[00:47:33] So the whole entire experience is deliciously ventral, like beyond like comprehension in some ways. Right. So it's just, it's just, bathed in this sense of connectivity and connection and, um, curiosity with each other and a lot of shared experience. So my grandson has a lot more intense sympathetic blending. He, he wants to, um, you know, kind of rough and tumble play. He wants to climb on you. wants figure out how to crash and burn
[00:48:10] things. Um, and that's all fine, but at some point it gets a little bit too big for my granddaughter and her proclivity, her kind of way of being in the world is to regroup with a little bit of downtime. So this is so beautiful to watch what will happen is that she'll start to do two things almost predictably from watching them. Um, she'll either start to move really slow and rhythmically and she'll say, I'm a ballerina. And then she'll do this like really slow movement and she gestures really slow She walks slowly and she moves slowly and she gets very bilateral and very rhythmic and she dials the whole thing down and it's just hilarious to watch or what she'll do is she gets flat. She lays on the floor.
[00:49:14] Michelle: wow.
[00:49:14] Tracy: And she'll get kind of quiet and as soon as she does that, because we're in ventral play, and even though my grandson is sort of big sympathetic energy, his ventral system is available enough that sees it. that change in energy, and then he'll dial down.
[00:49:34] So she has a very powerful vagal break over him more than he does really over her, because she really uses her energies in this kind of way of slowing the train down. And it was amazing to watch. And I imagine that she kind of learned how to do that because he was rough and tumbling when she was a little bit smaller and he have that, you know, and had to kind of help him stop so he squish or, or whatever. Um, but I think that she's really, she's also just in her personality a little bit of more, In that zenny chill kind of way, maybe a little bit like her, her Nana, maybe a little bit that way.
[00:50:23] This is kind of hilarious. I hadn't planned to share this story, but it really fits, right? it helps us to picture how our, our autonomic nervous systems are a part of our social nervous system and our, and playfulness is what constructs all of that. So working on that, the start and stop signaling, the rhythm. The, the cueing, you know, it's all how that all gets integrated and it's the foundation of regulation is how we draw from those energy sources and match them to the other and match them to the environment. And uh, it's so cool how it evolves from the playfulness itself. Yeah.
[00:51:10] Michelle: An they they have found this rhythm,
[00:51:15] you know what I mean? She's found a strategy, he's tuning in 'cause he's intention is to play and he's connected with her. So it was like. Oh, oh, oh, I better come over here and see what ballerina princess is taking rest from, you know, I better save her, whatever's going on for him, but they're, they're connected enough.
[00:51:31] I'm working, with siblings actually, two boys, and they are not taking stock. Um, you know, one of them isn't doing that. And so there isn't the pause between them. They both get energized and get chaotic and they pull away from, um, you know, Um, as the therapist and because they, their energies align and they feed each other and there's no, why would I want to stop?
[00:51:59] Cause this is awesome. You know, I can move mountains with this kind of energy. And when I'm with my brother, yeah, we can do it together. So the juice, you know, feeds them to keep going. And that's the challenge, I guess, for the parents and for us who are co treating with them. is that we then, um, wear the break, um, for them and because the two of them together, we have to be more appealing than them whizzing off.
[00:52:30] Um, which is every parent in the world's dilemma. If your kids are a little mismatched, which they always are at different points play doesn't always, you know, they don't always have that connectedness. Mine didn't. Um, yeah. So, so it's interesting because, um, They've got the dance happening without a lot of, um, adult intervention at the moment, I guess, or, or support I should say, to facilitate a pause and a noticing, Hey, where's the other one at?
[00:53:00] Um, but that's what, uh, our involvement and, and parent coaching is about, I guess.
[00:53:06] Cory: I wondered what we're talking about here is this, in Michelle's example with the siblings and with your grandkids, there's this autonomic, contribution to start and stop signaling in our nervous system and which we mentioned, but I wondered if we could talk about that, um, particularly as a therapeutic strategy in play. Because I'm sure Michelle, with your siblings, like a key strategy to support the break for the brothers is play. Like I'm assuming without the play, you can't maybe catch them enough to put the brakes on. Or can we just talk about that as a concept in treatment?
[00:53:46] Maybe
[00:53:46] Tracy: yeah, absolutely. So I think what happens is that, your energies, the autonomic energies are sort of, in a space sometimes of activation or deactivation. So with my grandkids, you can see that that activation and deactivation are happening in a co regulatory way each other. Sometimes what happens is that it's more co mobilized. So the brothers are like, activated together, but one of them isn't like more the co regulator to the other. They're just co active. They're co mobilized. Um, and so you have to have the triad of a, the environment, the rules, or another be the co regulator to help find that down regulation signal. And you know, what happens very often for kids is that people assert a rule. But what we often do in therapy, we may set a rule or we may say a boundary, but we may also join the, the kids in the play and kind of help them to find the stop signal that's coming inherently. So maybe it's like, okay, we're both going to climb up to the top of the ramp, but we can't jump off at the same time. So there's an automatic taking that would create a need for the break to come on. And in that you're going to invoke a lot more body in space, a lot more proprioception. The striatum and the motor planning circuitry is going to have to help you to find the start and stop. So, yeah, it starts to become in that sharing and it's very proprioceptive laden because it's about the, you know, if you think about the stop and go signal, it is. It's so based in our proprioceptors.
[00:55:41] Um, So I know in therapy that if I have kids who are upregulating so much that way and I need to help them find, a little bit more of a stop signal that if I can infuse more proprioceptive qualities and then the social quality of the you and the me, the you and the me, the you, and the me. Yeah creates the context for the boundary. And then the rule can grow out of that. Instead of imposing the rule of, it's your turn, you wait here. It's like, let them feel that. And that's really powerful,
[00:56:19] Cory: Yeah, what came mind for me is like climbing up the ramp with those kids girls or something. And sometimes I can be like, I really want to do that, but I'm going to struggle. Can you help me? Can you pull me? know, so sometimes, and that's proprioceptive, right? But depending on the child, so some kids will be like, yeah, I can help you. And sometimes they're like, I don't care.
[00:56:40] Michelle: Whoa.
[00:56:41] Cory: Get up yourself. I'm just going to keep jumping. Like, so it just depends on the way that I might, I might
[00:56:46] do that.
[00:56:46] Tracy: But it's also, you're pulling in that social nervous system, the prosocial cue of help me, the prosocial cue of my turn, your turn is an essential part of this regulatory capacity and the ventral vagus complex really helps us to be the most attuned to each other. So it is the social nervous system that we want to have be the fiery partner in this or the down regulation kind of chill partner, the breaking partner, but it's social in and it has that kind of quality and then the proprioceptors anchor it. Right. Yeah.
[00:57:32] Michelle: So that was our game. So there was a bit of this jostling and who was going to go first and who was winning and you know, who was successful. So we created this, the activity was to go from Danger Island. We had to, you know, this is classic OT kind of game. But, get across the lava onto safety island. And so what equipment could we use or what could we step on to avoid the lava? So, um, we brainstorm on the mat and, you know, it was a big heavy barrel. It was tires. It was crash mats. And then, and so it was all grounded last week. And so you had to hang on. And if you splattered down into lava, you'd reset.
[00:58:13] And, um, Yeah, the challenge, they were awesome at that. The challenge yesterday was to have it aerial. So we wanted a bit more vestib import and a bit more activation to see if we could have a bit of the structure of we're going to be successful and we all got to get to the island. So we just had all, they chose swings.
[00:58:33] So we were on the danger island on a crash mat, and that was our you know, place where we came together, we cheered each other on. So we got rid of that winning and losing, like team ninja needed to win so we stopped that competition, I guess. But when we were, had a lot more vestib activation, it was awesome and so good, but we certainly were heightened when it was really heavily prop they were much more grounded, but that's where we wanted, they climb trees and do all sorts of amazing stuff. So we wanted. To get, more activation in play and see if we could hold that connection with us. Anyway, it was awesome playful stuff.
[00:59:12] Tracy: Yeah. Yeah. Well, I'm so grateful to our OT colleagues who are doing all this great research in this space. And, you know, we'll share in the show notes some of the favorite resources for sure. But, um, I think it's like go forth and play is kind of the thing that we hope for everybody. Yeah.
[00:59:34] Michelle: Awesome.
[00:59:34] Bye.
[00:59:36]
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